What Do I Need To Do Before Traveling as a Dialysis Patient?

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What Do I Need To Do Before Traveling as a Dialysis Patient?

Answer: Planning is the most important thing a dialysis patient can do before traveling. Although dialysis is readily available for travelers throughout the United States and Canada, travel to other countries can be an adventure for dialysis patients. Don't let concerns about medical care or your ability to handle unexpected situations hold you back. With appropriate planning and a flexible and adventurous attitude, travel is well worth the effort. You can arrange foreign travel yourself, but just as with any other travel arrangements, a good, experienced travel agent can be invaluable.

Begin no less than three months in advance, contacting hemodialysis units surrounding the location you wish to visit. Your dialysis unit should be able to provide unit names and numbers, if not, try the American Association of Kidney Patients. Contact the dialysis units and ask for their requirements for accepting you as a transient patient. When traveling from city to city, take into consideration train connections and travel times.

You can contact the units yourself in a couple of ways. You can fax the units to request information, check availability or reserve a spot. You can also call European units directly. Many countries use English as a second language. You can also contact the units through AT&T's translation service. This service is expensive but it allows you to contact units yourself when English is not spoken.

As an alternative to contacting each dialysis unit separately, you can use a travel agent or special dialysis travel services like Holiday International (http://www.fresnet.it/dialysis). Holiday International is a division of Fresenius of Italy. They can prepare dialysis for you anywhere in the world, particularly Europe. Best of all, you can arrange everything through one office via e-mail and fax. This is easier than calling each unit individually from America, especially if you would have to use a translation service.

Dialysis in Europe is very similar to that in the United States. The machines and the treatment itself may be identical to those used here. Some of the amenities will differ however. For example, it is more common to dialyze in a bed in Europe, but some units use chairs. Dialysis units in Europe, like many homes, are not always air-conditioned. Reuse of dialyzers is also less common in Europe than it is in the United States.

For travel within the United States and Canada, arrangements can be made through your own dialysis unit. Many dialysis units accept transient patients, if they have a vacancy. The earlier you make plans, the more likely you are to find a dialysis unit near where you are visiting. Medical records will need to be exchanged, and some units may have special requirements for visiting patients. Medicare pays for dialysis treatments for eligible patients within the United States.

Medicare will not pay for dialysis outside of the United States and its territories. Some insurance companies will reimburse you for dialysis related expenses not covered by Medicare, including dialysis outside of the United States. The costs for dialysis may range from $280 - $1,000 in Europe, but averages about $400 for each treatment. If you arrange dialysis through a service, they may add an additional service fee.

Before you travel, you should know what the financial requirements are for each dialysis unit that you plan to use. Some dialysis units accept credit cards, while others require payment in the local currency after each treatment. At other units, advanced payment may be required.

You should take with you a recent copy of a chest x-ray and electrocardiogram report, a copy of your most recent laboratory tests, including an HIV test, and the results of a TB skin test. All of your immunizations should be current, including those for hepatitis B and the pneumonia vaccine. Some dialysis units have a policy against using a fax to send information about your HIV status and you may need to send it yourself. You should contact your primary care physician for information about special immunizations that may be required in some countries. Have copies of your current medication list, a complete history and physical examination and your dialysis orders. Although your dialysis unit may send or fax this information, you should carry a copy with you at all times. Wear a medical alert nametag complete with your diagnosis in at least two languages.

Carry double amounts of all the medications that you will need during your trip. Keep one set of medication with you at all times, since luggage may be lost or delayed. Some patients like to take a box of disposable gloves, since some countries still "wash" gloves. It is also a good idea to take gauze and tape in case of breakthrough bleeding of your access and some antibacterial soap to clean your access prior to dialysis. A translation book with common phrases may be useful and you should familiarize yourself with terms you may need to get across to the medical staff, such as "I am short of breath," or "it hurts here."

If you are taking electrical equipment, like a cycler, be sure the electric outlets are compatible. When you send CAPD supplies outside the country, they may be held in customs for several days. Hotels may accept deliveries of supplies, but may also charge to hold the supplies until check-in. Take enough supplies with you to make it through several days and lost shipments.

Remember, planning is the key to a successful trip. Give yourself plenty of time to make all the necessary arrangements. Have fun and share your experiences with other dialysis patients.

Answer provided by George Aronoff, MD, FACP. Dr. Aronoff is Professor of Medicine and Pharmacology and Chief, Division of Nephrology at the University of Louisville School of Medicine. Dr. Aronoff is a member of the AAKP Medical Advisory Board.